Texas Women Ponder Next Steps as Law Cuts Health Options

The 31-year-old Texas Christian University student and
married mother of two daughters said trying to find an
alternative provider is a “scary prospect.”

She’s just one among more than 126,000 low-income women who
may face the same dilemma by Nov. 1. That’s when funding for
services by Planned Parenthood affiliates will end because other
operations tied to the nonprofit group offer abortions.

The state will spend $40.1 million on its Women’s Health
Program through September 2013 and bar funding for groups
connected even indirectly to abortion providers. The cutoff
follows a showdown over the ban that pitted Governor Rick Perry,
the state’s longest-serving chief executive, against the U.S.
Health and Human Services Department and Medicaid. The health-
insurer for the poor has paid 90 percent of the program’s cost.

“The Texas Legislature, with a vigorous and open debate,
said we are not going to spend Texas taxpayer money on
abortion,” Perry, a Republican, said during a Sept. 21 forum
sponsored by the Texas Tribune, an online news outlet. State
officials, including Perry, have said they won’t put off
imposing the ban while pending lawsuits over it are resolved.

Long Wait

Lohse may end up going to a general-medical clinic that has
a long waiting list for appointments. Tens of thousands of women
served by the program may confront a similar situation, since
lawmakers previously cut state family-planning aid by two-
thirds, or $73 million, leading dozens of providers to close or
reduce hours.

Critics such as state Representative Donna Howard, an
Austin Democrat, say the cuts reduced potential replacements for
Planned Parenthood affiliates in the program. Those clinics
handled 43 percent of its patients, said Stephanie Goodman, a
state Health and Human Services Commission spokeswoman.

Started in January 2007 to help reduce costs associated
with births paid for by Medicaid, the program doesn’t cover pre-
natal services or abortions, according to a May commission
report to the Legislature. It reduced expected births by 8,215
in 2010, saving Medicaid $90.2 million, the report shows.

The program provides services that include contraceptives,
well-woman examinations and screenings for breast and cervical
cancer, sexually transmitted diseases and other conditions. It
covers women 18 to 44 with incomes of 185 percent or less of the
federal poverty level. About three-quarters of its clients are
under 30 years of age.

Cut Off

Responding to the abortion-related ban, federal
administrators cut off the state program, saying Texas can’t
block federally approved groups such as Planned Parenthood from
providing services underwritten by Medicaid, the health-
insurance system for low-income Americans.

Planned Parenthood-affiliated clinics that participate are
legally and financially separate from the organization’s
abortion operations, said Sarah Wheat, a spokeswoman for Planned
Parenthood of Greater Texas, which includes clinics in the
Austin, Waco and Dallas-Fort Worth areas.

“When you come after Planned Parenthood, basically, you
are coming after our clients,” Wheat said at a clinic near
downtown Austin. The provider served 2,300 program clients last
year and has a sign outside declaring, “This clinic is open!”

Taxpayer Cost

The state’s position will cost taxpayers more than $30
million a year in foregone Medicaid subsidies, state figures
show.

“It’s a political agenda, determined to completely derail
Planned Parenthood,” even though none of the program clinics
performed abortions, Wheat said.

Texas plans to run the program on its own terms, with its
own taxpayer dollars, cutting out Medicaid, which is jointly
funded by the states and the U.S. government.

Perry has made holding down state spending a central theme
of his 12 years as governor. He also has attacked the federal
government for encroaching on how Texas tax dollars are used.

In a March lawsuit against Health and Human Services
Secretary Kathleen Sebelius in U.S. district court in Waco,
state Attorney General Greg Abbott called the Medicaid funding
cutoff “an unconstitutional attempt to commandeer and coerce
the state of Texas into repealing its law that withholds
taxpayer money from elective-abortion providers.” No trial date
has been set for the suit.

Lawsuits Fly

In April, Planned Parenthood sued Texas, asserting that the
state ban violates its First Amendment right to free speech. A
federal appeals court in August upheld Texas’s right to enforce
its restriction. The organization is seeking a new hearing.

State Representative John Zerwas, a Republican from
Simonton, near Houston, and an anesthesiologist, said he’s
confident that the Legislature will keep funding the program.

“I do have some concerns about the relative access to
providers,” Zerwas said. “I haven’t yet seen real solid data
that access will be beefed up enough” to replace Planned
Parenthood affiliates.

Out of 240 clinics surveyed by the Population Research
Center at the University of Texas, 53 closed and 38 cut hours
after previous cuts in family-planning aid, according to a
report last week in the New England Journal of Medicine.

Data need to be collected on the effects of the earlier
cutbacks, Representative Zerwas said before he had seen the New
England Journal article. “The last thing we want to do is cut
family planning and then see an uptick in unwanted pregnancies,
adding to the Medicaid rolls or leading to abortion,” he said.

Widespread Effects

Some affected operations served parts of Texas with high
participation rates in the Women’s Health Program. A dozen were
Planned Parenthood affiliates, mostly in southern and western
areas of the state, Wheat said.

“I think it’s going to be tough to plug the hole with
other providers,” Representative Howard said. “When you have a
program with a nine-to-one match that was saving millions of
dollars and you pull the rug out from under these women, it is
not fiscally responsible.”

The state has recruited about 500 new providers in recent
months, said Goodman, the commission spokeswoman, bringing the
total to 3,000 physicians, clinics, laboratories and others.

“When we lose a group of clinics that are serving a large
number of women, we’re obviously concerned,” Goodman said,
referring to the changes that will take effect Nov. 1. “We’re
doing everything we can” to make sure that no clients are left
without care, she said.

85% Cut

Community Action Inc. in San Marcos has two remaining
family-planning and women’s health clinics for low-income
clients in rural areas near Austin and may be able to add
clients, said Carole Belver, the nonprofit’s health services
director. Just a few years ago, it had 13.

“I had to reduce hours for some of my already slim staff”
after the earlier family-planning cuts, Belver said in August
from San Marcos, about 30 miles (48 kilometers) south of Austin.
“It’s worse than bad. We’re just barely making it.”

Perry deserves credit for stepping in when Medicaid
refused to fund the program under the state’s new rules, said
Joe Pojman, executive director of the Texas Alliance for Life.

“He has put his political reputation on the line by
stating that this program will continue, with a seamless
transition,” Pojman said. “We think it’s more efficient for
the state and probably means better care for the women.”

Lohse, the Fort Worth student, isn’t so sure. With a
husband who’s also in school and working part-time, she holds
down two part-time jobs while she works on a degree in politics.
She said she can’t afford to get sick.

“It will go from the Women’s Health Program being a really
accessible way for me to get health care and stay healthy to
being really, really hard,” Lohse said.